[Treatment of progressive heart failure: pharmacotherapy, resynchronization (CRT), surgery]

Cardiac stem cell therapy. Registered trials and a pilot study in patients with dilated cardiomyopathy

In cardiac stem cell therapy, the past decade has been interesting with respect to preclinical and clinical research. The high diversity of applied stem cell populations and evaluation methods represent a challenge to fully understand the impact of stem cell administration, leaving uncertain answers to the questions that have been dealt with thus far. In the present work, registered studies in cardiac stem cell therapy are summarized and the study aims are highlighted. Furthermore, preliminary data on the additional intramyocardial administration of CD133+ stem cells in patients undergoing mitral valve surgery are presented.

Pediatric cardiomyopathies over the last decade: a retrospective observational epidemiology study in a tertiary institute, Egypt

BACKGROUND

Pediatric cardiomyopathy (CM) is a rare, life-threatening disorder of unknown etiology. Data on CM in Egypt are scarce as there is no national registry. This study was an effort to understand the demographic features, clinical presentation, and frequency of different types of childhood CM in Egypt.

MATERIALS AND METHODS

Medical files of all children diagnosed with CM in the last decade (1997-2007) and referred to the Pediatric Cardiology Clinic at Ain Shams University, Children's Hospital (Cairo, Egypt), were reviewed. This study included 124 (6.6%) cardiomyopathic patient files from a total of 1876 cardiac patients that were followed up at the Pediatric Cardiology Clinic during the 10-year study period.

RESULTS

In the last decade (1997-2007), children with CM represented 6.6% of all children with cardiovascular diseases followed at the Pediatric Cardiology Clinic; 73 were boys (58.9%) and 51 were girls (41.1%), with a mean age of 3.82±3.99 years. Parental consanguinity was positive in 19.4% of patients and a history of preceding viral infection was present in one patient (0.8%). Eight patients had a similarly affected sibling (6.5%).

CONCLUSION AND RECOMMENDATIONS

Data on CM in Egypt are scarce, highlighting the urgent need for a national registry for CM (a) to allow more accurate assessment of the size of this problem, especially in children; (b) to minimize loss of follow-up data when patients move from one region to another; and (c) to allow screening of family members of a proband case.

[Renoprotective effect of small volumes of hypertonic saline solution in chronic heart failure patients with marked fluid retention: results of a case-control study]

During intensive therapy of chronic heart failure (CHF) patients with marked fluid retention using high doses of i.v. furosemide the additional effect of agents which might exert osmotic attraction of interstitial fluids has been proposed. They are thought to impede the impairment of renal blood supply and glomerular filtration rate, which may be caused by a combined action of cardiac preload acute reduction, hypotension and neurohormonal activation.We therefore assessed in CHF patients with NYHA class III and BNP values from 900 to 1500 pg/ml, who were treated with i.v. furosemide, the predictors of iatrogenic short term creatinine impairment by means of a case-control observational study from two centers. Patients with CHF had been treated for 6-8 days with intravenous loop diuretics alone or with an additional i.v. administration of other agents (plasma expanders, albumin, mannitol, inotropic support etc.). A rise in serum creatinine ≥ 25% of the basal value was considered as renal impairment.A total of 15 cases and 38 controls were enrolled. At univariate analysis, serum creatinine basal value ≥ 2.2 mg/dl, absence of hypertonic saline solution (HSS) in the therapeutic protocol, hyposodic diet and refractory oligoanuria were associated with an increased risk of worsening renal function precipitated by i.v. diuretic therapy. At multivariate analysis as a predictor of loop diuretic-related renal function impairment, we found a serum creatinine ≥ 2.2 mg/dl at baseline (OR: 63.33, 95% CI: 3.68-1088.73, p=0.0043) and the absence of HSS in the therapeutic regimen (OR: 25.0461, 95% CI: 2.07-302.53, p=0.0113). Moreover, in multivariate analysis ascites had some predictive value of renal deterioration (OR: 13.28, 95% CI: 1.0055-175.41, p=0,0495).